Personal Protective equipment Master of Public Health Engineering

Personal Protective equipment

1. Personal Protective Equipment
(PPE)

2. History
William S HalstedJoseph Lister performing Surgery

3. History
•In 1890, William Halsted was using carbolic acid in the
operating theatre, as introduced by Joseph Lister after the
publication of germ theory.
•Since his nurse’s hands were sensitive to carbolic acid, in
order to prevent damage to her skin he asked the Goodyear
Tyre& Rubber Company if they could make a rubber glove
which could be dipped in carbolic acid.
•Subsequently, the first disposable latex medical gloves were
manufactured in 1964 by Ansell

4. PPE Use in Healthcare Settings:
•Improve personnel safety in the healthcare
environment through appropriate use of PPE
•The primary aim of using PPE in health care
settings is to protect the skin and mucous
membranes of HCWs from exposure to blood and/
or body fluid
•Prevents contamination of clothing and reduces
the opportunity of spread of microbes from patients
and/or fomites to other patients, staff, and
environments
PPE Use in Healthcare Settings

5. PPE Use in Healthcare Settings:
Objectives
•PPE conforming to appropriate national/ international standards
should be used.
•Decision to use and select appropriate PPE must be based upon an
assessment of the level of risk associated with contamination of
skin, mucous membranes, and clothing by blood and/or body fluids
from a specific patient care activity or intervention
•Provide information on the selection and use of PPE in healthcare
settings
•Education and Practice how to safely don and remove PPE
PPE Use in Healthcare Settings

6. Personal Protective Equipment
Definition
“Specialized clothing or equipment worn by an
employee for protection against infectious
materials” (OSHA)
PPE Use in Healthcare Settings

7. Regulations and Recommendations for
PPE
•OSHA issues workplace health and safety
regulations. Regarding PPE, employers must:
–Provide appropriate PPE for employees
–Ensure that PPE is disposed or reusable PPE is cleaned,
laundered, repaired and stored after use
•OSHA also specifies circumstances for which PPE is
indicated
•CDC recommends when, what and how to use PPE
PPE Use in Healthcare Settings

8. Hierarchy of Safety and Health
Controls
•Training and administrative controls
•Engineering controls
•Work practice controls
•Personal protective equipment
PPE Use in Healthcare Settings

9. Common Types of PPE
Head
Eyes
Face
Hands
Feet
Body
Hearing
Respiratory

10. Types of PPE Used in
Healthcare Settings
•Gloves –protect hands
•Gowns/aprons –protect skin and/or clothing
•Masks and respirators–protect mouth/nose
–Respirators –protect respiratory tract from airborne
infectious agents
•Goggles –protect eyes
•Face shields –protect face, mouth, nose, and eyes
PPE Use in Healthcare Settings

11. Factors Influencing PPE Selection
•Type of exposure anticipated
–Splash/spray versus touch
–Category of isolation precautions
•Durability and appropriateness for the task
•Fit
PPE Use in Healthcare Settings

12. Gloves
•Purpose –patient care, environmental
services, other
•Glove material –vinyl, latex, nitrile, other
•Sterile or non-sterile
•Oneor two pair
•Single useor reusable
PPE Use in Healthcare Settings

13. Functions of Gloves
•Provide a protective barrier and prevent contamination of the
hands when touching blood and/or body fluids from a patient
or fomites.
•Sterile gloves reduce the likelihood of transmission of
microorganisms from the HCW’s hands to the patient during
sterile and invasive procedures.

14. Do’s and Don’ts of Glove Use
•Work from “clean to dirty”
•Limit opportunities for “touch contamination” -
protect yourself, others, and the environment
–Don’t touch your face or adjust PPE with
contaminated gloves
–Don’t touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings

15. Do’s and Don’ts of Glove Use
•Change gloves
–During use if torn and when heavily soiled (even
during use on the same patient)
–After use on each patient
•Discard in appropriate receptacle
–Never wash or reuse disposable gloves
PPE Use in Healthcare Settings

16. Issues with Gloves usage:
•Creates a moist, warm, and occlusive environment between
the skin and the glove which supports microbial growth
•Prolonged and inappropriate use of gloves can be a hazard
and has been associated with cross-infection and should be
avoided
•Once the task is finished, hands must be washed immediately
after removal to prevent cross contamination.
•Gloves must be changed both between patient contacts and
between separate procedures on the same patient.

20. Latex allergy
•Latex protein causes Type 1 Hypersensitivity
•Chemicals used in processing latex products
might cause Type 4 Hypersensitivity
•Glove powder aerosolizes latex proteins
causing the allergens to be inhaled by both
the glove wearer and others in the immediate
environment.

21. Gowns or Aprons
•Purpose of use
•Worn when there is a risk that clothing or
uniforms may become exposed to blood
and/or body fluids
•Material –
–Natural or man-made
–Reusable or disposable
–Resistance to fluid penetration
•Clean or sterile
PPE Use in Healthcare Settings

22. Face Protection
•Surgical Masks –protect nose and mouth
•Should fully cover nose and mouth and prevent
fluid penetration
•Surgical masks provide protection against droplets nuclei
because they are not designed to provide a close facial
seal Which is essential for protection of airborne
particles of <5 μ
PPE Use in Healthcare Settings

23. Respiratory Protection
•Purpose –protect from inhalation of infectious aerosols (e.g.,
Mycobacterium tuberculosis)
The respirator provides protection against inhalation of very tiny
(<5 microns in size) airborne particles to the HCWs. They
should be close fitting and must filter particles of size of 1–5 μm.
Should be used in all Aerosol Generating Procedures (AGPs)
•PPE types for respiratory protection
–Particulate respirators
–Half-or full-face elastomeric respirators
–Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings

24. Types of Respirators
•Air purifying Respirator
–Aerosol removing respirators
–Gas/Vapour removing respirators
–Powered air purifying respirators
•Atmosphere supplying respirators
–Supplied air respirator
–Self containing breathing apparatus
•Combination of Air purifying and Atmosphere
supplying respirators

25. Respirators classification
•NIOSH certified respirators:
–Ex. N95 mask
•N : Non –Oil Based
•R : Oil present , but for single use / 8 hours
•P: Oil present , can be re-used
95 : 95% efficiency in filtering 0.3 μmparticles
•European standards (BS EN 149: 2001 Standard)
–‘Filtering face piece’ (FFP1, 2, 3) at flow 95L/min
•BS 143: particle filters attached to Masks: P1, 2,
3 at 80%, 94%, 99% filtration standards

26. Spot the difference

27. R95 respirator
P100 respirator

28. Elements of a Respiratory
Protection Program
•Medical evaluation
•Fit testing
•Training
•Fit checking before use
•Respiratory masks are unsuitable for HCWs with facial
hair as it affects the seal between the mask and the face.
PPE Use in Healthcare Settings

29. Face Protection
•Goggles –protect eyes
–Should fit snuggly over and around eyes
–Personal glasses not a substitute for goggles
–Antifogfeature improves optical clarity
–Distortion free, shielded at sides
•Face shields –protect face, nose, mouth, and
eyes
–Should cover forehead, extend below chin and wrap
around side of face
PPE Use in Healthcare Settings

30. Head PPE
Needed when employees are exposed to
hazards that have potential to cause a head
injury.
Examples of hazards:
Flying objects.
Falling objects or materials.
Working near exposed energized electrical
equipment.
Working around or on scaffolds.
Working at construction sites.
Working around overhead tools or machinery.

31. Types of Head Protection
Impact Protection
Type I –Is designed to protect only against objects falling
from straight overhead, hitting the hardhat on the top.
Type II –Is designed to protect against blows on the top of the
head as well as side impacts.
Electrical
Class A (old American National Standards Institute standard) or
Class G (new ANSI Standard) good up to 2,200 volts.
Class B (old ANSI standard) or Class E (new ANSI Standard)
good up to 20,000 volts.
Class C not rated for electrical protection.

32. Donning Head Protection
Hard hat protection is effective only if the hat is adjusted
to fit properly and is worn squared and not cocked at an
angle or perched on the back of the head.
Severe lacerations from relatively light blows have been
incurred by workers wearing hard hats in unusual
positions.
Must not be worn backwards.

33. Head Caps
•Caps that completely cover the hair are used when splashes
of blood and body fluids are expected.
•They should protect the hair from aerosols that may
otherwise lodge on the hair and be transferred to other parts
of the health care worker such as face or clothing by the
hands or onto inanimate objects.
•Disposable, waterproof cap of an appropriate size which
completely covers the hair should be used

34. Eye PPE
Needed when an employee work presents the
potential of causing eye injury from physical, chemical,
or radiation agents.
Examples of hazards:
Machines
Lasers
Impacts
Heat
Tools
Flying Particles / Dust
Electrical work
Chemical handling

35. Types of Eye Protection
Goggles
Chemical
Laser
Welding
Chemical goggles protect your eyes, eye sockets, and
the facial area immediately surrounding the eyes from
impact, dust, and splashes.
Chemical goggles are generally stronger than safety
glasses and are used for higher impact, particle and
chemical splash protection.
Laser and Welding goggles protect the eyes from
harmful light.

36. Face PPE
Needed when work presents the potential
of causing facial injury from physical,
chemical, or radiation agents.
Examples of hazards:
Contents under pressure
Splash hazard
Flying objects / particles
Electrical work

37. Types of Face Protection
Face Shield
Welding Shield

38. Hand PPE
Needed when work presents the potential of
causing hand injury from physical, chemical, or
radiation agents.
Examples of hazards:
Absorbing harmful substances
Sharp objects capable of causing cuts, abrasions, or
punctures
Chemical or thermal burns
Electrical work
High/Low temperatures

39. Types of Hand Protection
Chemical Resistant -
Puncture / cut / abrasion Resistant
Those with a latex allergy can use vinyl, nitrile, etc. based on the
compatibility charts

41. Feet PPE
Needed when work presents hazards that
have potential to cause a foot injury:
Examples of hazards:
Falling objects
Rolling objects
Piercing/cutting injuries
Electrical work
Chemical exposure

42. Types of Foot Protection
Steel toed
Electrical resistant –(will have the letters
“EH” on the tongue)
Chemical resistant

43. Body PPE
Needed when work presents a potential for contamination
or injury to other parts of the body such as legs, arms,
back, chest.
Examples of hazards:
Heat
Splashes
Hot/cold metals and liquids
Impacts
Sharp objects
Chemicals
Electrical work
Radiation

44. Types of Body Protection
Lab coats
Aprons
Chemical resistant sleeves
Tyvek suits
Coveralls
Arc Flash Rated

45. Hearing PPE
Needed when the average (over an 8 hour period)
noise level of an area reaches 90 decibels.
Hearing protection must be made available to
employees when the average (over an 8 hour
period) noise level reaches 85 decibels.
Examples of high noise areas can be:
Mechanical rooms
Shops
Construction Sites
When working with machinery/power tools

46. Types of Hearing Protection
Ear Plugs
Ear Muffs
Canal Caps

47. Donning Hearing Plugs
Follow manufacturers recommendations. The
steps below is a commonly used method.
1.Rollthe earplug up into a small, thin "snake"
with your fingers. You can use one or both hands.
2.Pullthe top of your ear up and back with your
opposite hand to straighten out your ear canal.
The rolled-up earplug should slide right in.
3.Holdthe earplug in with your finger. Count to
20 or 30 out loud while waiting for the plug to
expand and fill the ear canal. Your voice will sound
muffled when the plug has made a good seal.

48. PPE Cleaning and Care
PPE must be kept clean and sanitary. Clean PPE with mild soap
and water . Some PPE may require special cleaning, in these cases
use the manufacturer’s recommendations.
If PPE is contaminated and cannot be decontaminated safely, it may
need disposed of in a special manner to protect other employees
from exposure to the hazard. EHS shall be contacted.
PPE shall be stored in such a way that it will not become
contaminated such as plastic bags, lockers, closet, drawers.

49. For additional information on
respirators….
•http://www.cdc.gov/niosh/npptl/respirators/
respsars.html
•http://www.cdc.gov/niosh/99-143.html
•http://www.cdc.gov/niosh/topics/respirators
PPE Use in Healthcare Settings

50. PPE Use in Healthcare Settings:
How to Safely Don, Use, and
Remove PPE

51. Key Points About PPE
•Don before contact with the patient, generally
before entering the room
•Use carefully –don’t spread contamination
•Remove and discard carefully, either at the
doorway or immediately outside patient room;
remove respirator outside room
•Immediately perform hand hygiene
PPE Use in Healthcare Settings

52. Sequence* for Donning PPE
•Gown first
•Mask or respirator
•Goggles or face shield
•Gloves
*Combination of PPE will affect sequence –be practical
PPE Use in Healthcare Settings

53. How to Don a Gown
•Select appropriate type and size
•Opening is in the back
•Secure at neck and waist
•If gown is too small, use two gowns
–Gown #1 ties in front
–Gown #2 ties in back
PPE Use in Healthcare Settings

54. How to Don a Mask
•Place over nose, mouth and chin
•Fit flexible nose piece over nose bridge
•Secure on head with ties or elastic
•Adjust to fit
PPE Use in Healthcare Settings

55. How to Don a Particulate
Respirator
•Select a fit tested respirator
•Place over nose, mouth and chin
•Fit flexible nose piece over nose bridge
•Secure on head with elastic
•Adjust to fit
•Perform a fit check –
–Inhale –respirator should collapse
–Exhale –check for leakage around face
PPE Use in Healthcare Settings

56. How to Don Eye and Face
Protection
•Position goggles over eyes
and secure to the head using
the ear pieces or headband
•Position face shield over face
and secure on brow with
headband
•Adjust to fit comfortably
PPE Use in Healthcare Settings

57. How to Don Gloves
•Don gloves last
•Select correct type and size
•Insert hands into gloves
•Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings

58. How to don a head cap

59. How to Safely Use PPE
•Keep gloved hands away from face
•Avoid touching or adjusting other PPE
•Remove gloves if they become torn; perform
hand hygiene before donning new gloves
•Limit surfaces and items touched
PPE Use in Healthcare Settings

60. PPE Use in Healthcare Settings:
How to Safely Remove PPE

61. “Contaminated” and “Clean”
Areas of PPE
•Contaminated –outside front
•Areas of PPE that have or are likely to have been in
contact with body sites, materials, or environmental
surfaces where the infectious organism may reside
•Clean –inside, outside back, ties on head
and back
•Areas of PPE that are not likely to have been in
contact with the infectious organism
PPE Use in Healthcare Settings

62. Sequence for Removing PPE
•Gloves
•Face shield or goggles
•Gown
•Mask or respirator
•Head cap
PPE Use in Healthcare Settings

63. Where to Remove PPE
•At doorway, before leaving patient room or in
anteroom*
•Remove respirator outside room, after door
has been closed*
*Ensure that hand hygiene facilities are available at the point
needed, e.g., sink or alcohol-based hand rub
PPE Use in Healthcare Settings

64. How to Remove Gloves (1)
•Grasp outside edge near
wrist
•Peel away from hand,
turning glove inside-out
•Hold in opposite gloved
hand
PPE Use in Healthcare Settings

65. How to Remove Gloves (2)
•Slide ungloved finger
under the wrist of the
remaining glove
•Peel off from inside,
creating a bag for both
gloves
•Discard
PPE Use in Healthcare Settings

66. Remove Goggles or Face Shield
•Grasp ear or head
pieces with ungloved
hands
•Lift away from face
•Place in designated
receptacle for
reprocessing or disposal
PPE Use in Healthcare Settings

67. Removing Isolation Gown
•Unfasten ties
•Peel gown away from
neck and shoulder
•Turn contaminated
outside toward the inside
•Fold or roll into a bundle
•Discard
PPE Use in Healthcare Settings

68. Removing a Mask
•Untie the bottom, then
top, tie
•Remove from face
•Discard
PPE Use in Healthcare Settings

69. Removing a Particulate Respirator
•Lift the bottom elastic
over your head first
•Then lift off the top
elastic
•Discard
PPE Use in Healthcare Settings

70. Hand Hygiene
•Perform hand hygiene immediately after
removing PPE.
–If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove PPE
•Wash hands with soap and water or use an
alcohol-based hand rub
PPE Use in Healthcare Settings
*Ensure that hand hygiene facilities are available at the point
needed, e.g., sink or alcohol-based hand rub

71. PPE Use in Healthcare Settings:
When to Use PPE

72. Standard and Expanded
Isolation Precautions

73. Standard Precautions
•Previously called Universal Precautions
•Assumes blood and body fluid of ANY patient
could be infectious
•Recommends PPE and other infection control
practices to prevent transmission in any
healthcare setting
•Decisions about PPE use determined by type
of clinical interaction with patient
PPE Use in Healthcare Settings

74. PPE for Standard Precautions (1)
•Gloves–Use when touching blood, body
fluids, secretions, excretions, contaminated
items; for touching mucus membranes and
nonintact skin
•Gowns–Use during procedures and patient
care activities when contact of clothing/
exposed skin with blood/body fluids,
secretions, or excretions is anticipated
PPE Use in Healthcare Settings

75. PPE for Standard Precautions (2)
•Mask and goggles or a face shield–Use
during patient care activities likely to generate
splashes or sprays of blood, body fluids,
secretions, or excretions
PPE Use in Healthcare Settings

76. What Type of PPE Would You
Wear?
•Giving a bed bath?
•Suctioning oral secretions?
•Transporting a patient in a
wheel chair?
•Responding to an
emergency where blood is
spurting?
•Drawing blood from a
vein?
•Cleaning an incontinent
patient with diarrhea?
•Irrigating a wound?
•Taking vital signs?
PPE Use in Healthcare Settings

77. What Type of PPE Would YouWear?
•Giving a bed bath?
•Generally none
•Suctioning oral secretions?
•Gloves and mask/goggles or a
face shield –sometimes gown
•Transporting a patient in a
wheel chair?
•Generally none required
•Responding to an emergency
where blood is spurting?
•Gloves, fluid-resistant gown,
mask/goggles or a face shield
•Drawing blood from a vein?
•Gloves
•Cleaning an incontinent patient
with diarrhea?
•Gloves w/wo gown
•Irrigating a wound?
•Gloves, gown, mask/goggles
or a face shield
•Taking vital signs?
–Generally none
PPE Use in Healthcare Settings

78. PPE for Expanded Precautions
•Expanded Precautions include
–Contact Precautions
–Droplet Precautions
–Airborne Infection Isolation
PPE Use in Healthcare Settings

79. Use of PPE for Expanded Precautions
•Contact Precautions –Gown and gloves for contact
with patient or environment of care (e.g., medical
equipment, environmental surfaces)
•In some instances these are required for entering patient’s
environment
•Droplet Precautions –Surgical masks within 3 feet
of patient
•Airborne Infection Isolation –Particulate respirator*
*Negative pressure isolation room also required
PPE Use in Healthcare Settings

80. Hand Hygiene
•Required for Standard and Expanded Precautions
•Perform…
–Immediately after removing PPE
–Between patient contacts
•Wash hands thoroughly with soap and water or
use alcohol-based hand rub
PPE Use in Healthcare Settings

81. PPE Use in Healthcare Settings:
Final Thoughts
•PPE is available to protect you from exposure
to infectious agents in the healthcare
workplace
•Know what type of PPE is necessary for the
duties you perform and use it correctly